Background: Acute coronary syndrome (ACS) remains a cause of high morbidity and mortality among adults, despite advances in treatment. Treatment modality and outcomes of ACS mainly depend on the time yielded since the onset of symptoms. Prehospital delay is the time between the onset of myocardial ischemia/infarction symptoms and arrival at the hospital, where either pharmacological or interventional revascularization is available. This delay remains unacceptably long in many countries worldwide, including Bangladesh. The current study investigates several sociodemographic characteristics as well as clinical, social, and treatment-seeking behaviors, with an aim to uncover the factors responsible for the decision time to get medical help and home-to-hospital delay. Materials and Methods: A prospective cross-sectional study was conducted between July 2019 and June 2020 in 21 district hospitals and 6 medical college hospitals where cardiac care facilities were available. The population selected for this study was patients with ACS who visited the studied hospitals during the study period. Following confirmation of ACS, a semi-structured data sheet was used to collect the patient data and was subsequently analyzed. Results: This study evaluated 678 ACS patients from 30 districts. The majority of the patients were male (81.9%), married (98.2%), rural residents (79.2), middle-aged (40–60 years of age) (55.8%), low-income holders (89.4%), and overweight (56.9%). It was found that 37.5% of the patients received their first medical care after 12 h of first symptom presentation. The study found that the patients’ age, residence, education, and employment status were significant factors associated with prehospital delay. The patients with previous myocardial infarction (MI) and chest pain arrived significantly earlier at the hospital following ACS onset. Location of symptom onset, first medical contact with a private physician, distance from symptom onset location to location of first medical contact, the decision about hospitalization, ignorance of symptoms, and mode of transportation were significantly associated with prehospital delay. Conclusions: Several factors of prehospital delay of the ACS patients in Bangladesh have been described in this study. The findings of this study may help the national health management system identify the factors related to treatment delay in ACS and thus reduce ACS-related morbidity and mortality.

Coronary artery perforation, a rare but deadly complication of percutaneous coronary intervention (PCI), can be managed by several modalities, including balloon inflation, heparin-reversing agent, thrombin injection, microcoils, fat embolization, covered-stent implantation, or surgery. We share our experience in emergency innovative management of coronary perforation during routine PCI. We faced an Ellis class III perforation of the right coronary artery during PCI. The balloon inflation technique failed to occlude the perforation, and no other facility was available to solve the problem immediately. The patient developed mild pericardial effusion but was hemodynamically stable. We made a covered stent by wrapping it with polyurethane (Tegaderm® skin dressing material) and deployed it. The perforation was sealed. The patient was discharged in stable condition and doing well at a 12-month follow-up examination. Hand-made covered stent may be a good bailout option to seal coronary perforation where premounted covered stents are not readily available.

Clinicians have long recognized that acute myocardial infarction (MI) can occur in the absence of atherothrombosis . The Universal Definition of MI Global Taskforce introduced a classification system in 2007 (and reaffirmed in 2012) that defined type 2 MI (following standard diagnostic criteria) as MI occurring due to an imbalance in myocardial oxygen supply and/or demand not caused by atherosclerotic plaque disruption. Nevertheless, ambiguity remains regarding how to diagnose type 2 MI and how to distinguish it from both type 1 MI and myocardial injury. Here we report a case of a 23 year old young woman attended to emergency department, with typical chest pain and shortness of breath for 6 hours, Diarrhoea for 2 days, and single time loss of consciousness for 5 minutes, 6 hours before attending to hospital. Cardiac enzymes were rising titres in subsequent samples, Serum Creatinine was also high. Echocardiography performed 36 hour later, showed no regional wall motion abnormality, coronary angiogram showed normal coronary arteries. So, a diagnosis of Myocardial Infarction (Type 2 MI) with Non Obstructive Coronary Artery (MINOCA) was made, and MINOCA was attributed to hypovolemic shock (resulting from Dirrrahoea), manifested as MI, Syncope and AKI. University Heart Journal 2022; 18(2): 128-131

Background: Coronary angiography and percutaneous coronary intervention are essential procedures for managing coronary artery disease but expose patients and healthcare personnel to ionizing radiation. Radiation exposure varies with procedural complexity and vascular access route, and repeated occupational exposure in catheterization laboratories (cath-labs) has been linked to serious health hazards among operators. Objectives: Given the high procedural volume and limited routine monitoring at Bangladesh Medical University (BMU), Bangladesh, this study aimed to quantify operator radiation exposure and identify factors influencing radiation dose. Methods: This analytical cross-sectional study was conducted from November 2023 to April 2024 in two cardiac cath-labs at BMU using two Siemens Axiom Artis angiography systems. Patient, operator, and procedural data, including demographics, operator experience, procedure type, vascular access route, fluoroscopic view, procedure duration, and radiation exposure, were collected from randomly selected routine procedures. Operator radiation exposure was measured at four working positions using a dosimeter, and cumulative annual exposure was estimated based on procedural workload. Descriptive, univariable, and multivariable analyses were performed to identify factors associated with radiation exposure. Results: The study analyzed 776 procedures, in which most patients were aged 46–65 years and male. The majority of procedures were coronary angiography performed via the femoral route. On average, each procedure required 14.28 fluoroscopic views and lasted 8.16 min, with a mean radiation exposure of 1034.5 mGy. Procedural complexity, radial access, and stent use were associated with higher fluoroscopic views, longer procedure time, and increased radiation exposure. Multivariable analysis showed that procedure type and stent number are primarily determinants for the number of fluoroscopic views, while procedure time was mainly driven by imaging demand and vascular access route. Radiation exposure was strongly associated with both procedure time and the number of views, and was higher among male and older patients but slightly lower with femoral access and among older operators. Direct measurements showed higher radiation levels near the operator’s X-ray beam, while estimated annual operator exposure remained low inside the lead apron (0.03–0.05 mSv) compared with outside the lead apron (0.6–1.1 mSv), which is within the limit of internationally accepted cumulative absorbed radiation. Conclusions: This study provides the first comprehensive evaluation of operator radiation exposure in a cardiac cath-lab in the country and the wider region. Procedural characteristics, particularly fluoroscopy use and procedural complexity, were the primary determinants of radiation exposure, while effective shielding and increased distance substantially reduced operator dose. These findings highlight the importance of imaging optimization and consistent implementation of the ALARA principle through structured radiation safety training and careful procedural planning to further minimize occupational exposure.

Not available University Heart Journal Vol. 9, No. 2, July 2013; 107-111